Zambia's first Mpox case: An emerging challenge in Southern Africa amid a global health crisis

Dear Editor,

Zambia on October 10, 2024 reported its first confirmed case of mpox, marking a significant development in the country's public health landscape [1]. The case involves a 32-year-old Tanzanian national who presented with symptoms such as muscle aches, fatigue, and sore throat shortly after extensive travel within Zambia. This development comes amidst a global resurgence of mpox, driven primarily by the emergence of a new clade 1b variant. The World Health Organization declared mpox a global public health emergency, as the clade 1b strain spread from the Democratic Republic of Congo to neighboring countries [2].

The patient's travel history and interaction across various regions in Zambia have heightened concerns regarding the possibility of undetected transmission chains, as contact-tracing efforts are underway. The health ministry's efforts to enhance risk communication and engage communities aim to contain the outbreak and reduce its further spread. This situation underscores the challenges faced by many African countries in addressing emerging infectious diseases, which are exacerbated by limited healthcare resources and underdeveloped diagnostic infrastructure [3]. The case also reflects the broader context of mpox's epidemiological shift, where the virus has expanded beyond its traditional endemic zones in Central and West Africa, largely due to factors such as population movement, changing environmental conditions, and waning immunity from smallpox vaccination cessation.

Clade 1b, the suspected variant, has attracted global attention because of its increased transmissibility. Genomic studies suggest a higher mutation rate, with approximately 50 single-nucleotide polymorphisms, compared to previous strains [2]. These genetic changes are associated with enhanced transmission potential, alterations in clinical presentation, and possibly, higher virulence. The rapid spread of the variant in regions such as the Democratic Republic of Congo, where it has been linked to a significant number of pediatric cases with high mortality, raises further concern. Zambia's case adds to the mounting evidence that clade 1b may pose a unique threat in settings with vulnerable populations, such as refugee camps and resource-limited communities, where public health interventions are challenging to implement.

The declaration of mpox as a Public Health Emergency of International Concern has prompted efforts to accelerate vaccine distribution and deploy antivirals, such as tecovirimat and brincidofovir. Nonetheless, access to these interventions remains inequitable, particularly in low-income countries. The situation in Zambia reflects the need for a coordinated international response that prioritizes equity in resource allocation of resources [4]. Expanded vaccination programs targeting high-risk populations and healthcare workers are critical to contain the outbreak. Concurrently, enhancing the diagnostic capabilities and genomic surveillance will play a pivotal role in tracking the evolution of the virus and informing response strategies.

In conclusion, Zambia's experience underscores the global impact of localized outbreaks and the need for investment in disease preparedness, especially in low-risk regions. A proactive approach with strong surveillance, community engagement, international collaboration, and One Health strategy is crucial to control the mpox and protect health and socioeconomic stability as the virus evolves [5].

CRediT authorship contribution statement

Rodrigue Ndabashinze: Conceptualization, Validation, Writing – original draft, Writing – review & editing. Benjamin Wafula Simiyu: Project administration, Validation, Writing – original draft, Writing – review & editing. Sanjit Sah: Writing – original draft, Writing – review & editing. Rachana Mehta: Writing – original draft, Writing – review & editing. Ganesh Bushi: Writing – original draft, Writing – review & editing. Ashok Kumar Balaraman: Writing – original draft, Writing – review & editing. Sakshi Pandey: Writing – original draft, Writing – review & editing. Manvinder Brar: Writing – original draft, Writing – review & editing. Amogh Verma: Supervision, Writing – original draft, Writing – review & editing.

Assistance with the study

No assistance received.

Financial support and sponsorship

All authors declare no financial support or sponsorship for this study.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Handling Editor: Patricia Schlagenhauf